and Pilar González-Peramato2
Keywords
Testicular neoplasmsPrimary testicular lymphomaPrimary testicular plasmacytomaTesticular interdigitating dendritic cell tumorThe existence of primary lymphomas of the testis is a controversial fact. It is true that in some cases testicular involvement is the only manifestation of a lymphoma, but it is also true that most cases spread rapidly, suggesting that they may have been the clinical manifestation of an occult lymphoma. The selected cases are a follicular lymphoma in the pediatric age due to the peculiar expression of Bcl6 and two lymphomas in adulthood. A testicular plasmacytoma and an interdigitating dendritic cell tumor are also included in this chapter.
6.1 Lymphoma
Case 93. Primary Follicular Lymphoma of the Pediatric Testis
Clinical case. A 3-year-old boy with an enlarged left testicle. The ultrasound showed a hypoechoic nodule 1.8 cm in diameter. Serum levels of testicular tumor markers were negative.
Comments. Pediatric follicular lymphomas are considered a variety distinct from adult follicular lymphomas. The histology of pediatric testicular lymphomas is similar to that of adult large cell B-cell lymphomas. Immunohistochemically, the most interesting datum is that the tumor cells express Bcl6. This fact suggests that there are two different tumors. In pediatric lymphomas, the translocation between the immunoglobulin heavy chain on chromosome 14 and the Bcl2 gene on chromosome 18 has not been observed, so they do not have Bcl2 overexpression. On the other hand, none of the pediatric follicular lymphomas expresses p53 protein, which frequently occurs in adult follicular lymphomas. And finally, the prognosis is excellent.
References
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Pileri SA, Sabattini E, Rosito P, Zinzani PL, Ascani S, Fraternali-Orcioni G, Gamberi B, Piccioli M, Vivenza D, Falini B, Gaidano G. Primary follicular lymphoma of the testis in childhood: an entity with peculiar clinical and molecular characteristics. J Clin Pathol. 2002;55:684–8.
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Heller KN, Teruya-Feldstein J, La Quaglia MP, Wexler LH. Primary follicular lymphoma of the testis: excellent outcome following surgical resection without adjuvant chemotherapy. J Pediatr Hematol Oncol. 2004;26:104–7.
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Lones MA, Raphael M, McCarthy K, Wotherspoon A, Terrier-Lacombe MJ, Ramsay AD, Maclennan K, Cairo MS, Gerrard M, Michon J, Patte C, Pinkerton R, Sender L, Auperin A, Sposto R, Weston C, Heerema NA, Sanger WG, von Allmen D, Perkins SL. Primary follicular lymphoma of the testis in children and adolescents. J Pediatr Hematol Oncol. 2012;34:68–71.
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Liu Q, Salaverria I, Pittaluga S, Jegalian AG, Xi L, Siebert R, Raffeld M, Hewitt SM, Jaffe ES. Follicular lymphomas in children and young adults: a comparison of the pediatric variant with usual follicular lymphoma. Am J Surg Pathol. 2013;37:333–43.
Case 94. Primary Diffuse Large B-Cell Lymphoma Germinal Center Phenotype
Cinical case. A 29-year-old patient who consulted due to a voluminous ulcerated mass in his left testicle since several months ago, that did not remit with antibiotic therapy. The Doppler ultrasound revealed a heterogeneous mass with flow in which it is difficult to distinguish the testicle form what is suspected to be a testicular tumor. Testicular tumor markers were negative. Left hemiscrotectomy, removal of the mass and four identifiable cm of spermatic cord was performed.